Maximum Grip Strength Research Articles

A Systematic Review of Musculoskeletal Fitness Among Indigenous Populations in North America and Circumpolar Inuit Populations.

North American indigenous populations experience higher rates of obesity and chronic disease compared with nonindigenous populations. Improvements in musculoskeletal fitness can mitigate negative health outcomes, but is not well understood among indigenous populations. This review examines musculoskeletal fitness measures among North American indigenous populations. A total of 1632 citations were evaluated and 18 studies were included. Comparisons of musculoskeletal fitness measures between North American indigenous men and boys and women and girls were generally not reported. The greatest left and right combined maximal grip strength and maximal leg strength among Inuit boys and men and girls and women were observed among 20-29 years age group. Maximal combined right and left grip strength declined from 1970 to 1990, by an average of 15% among adults and 10% among youth. Maximal leg extension among Inuit has declined even further, averaging 38% among adults and 27% among youth from 1970 to 1990. Inuit men demonstrate greater grip strength and lower leg strength than Russian indigenous men, whereas Inuit women demonstrate greater leg strength. Further research is needed to better understand physical fitness among indigenous peoples and the potential for improving health and reducing chronic disease risk for indigenous peoples through physical fitness.

Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study.

Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. Proof-of-concept, pilot, randomized controlled trial. University hospital. Twenty adult outpatients with distal radius fracture due to wrist injury. All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.

The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis.

Lateral epicondylitis (LE) is a common problem of the arm. Mulligan has proposed the use of mobilization with movement for LE. To investigate the effects of Mulligan's mobilization with movement (MWM) in LE. Forty patients were included in the study and randomly assigned to group 1 (n= 20), who received MWM, exercise and cold therapy, or group 2 (n= 20), who received exercise and cold therapy. The sessions were conducted five times a week for two weeks. All measures were conducted at baseline, after treatment, at 1st and 3rd months follow-ups. Mann-Whitney U test, a visual analogue scale (VAS) for pain intensity, Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire for pain intensity and functional disability and a dynamometer for hand grip strength were applied. VAS activity pain significantly decreased in group 1 after treatment (p= 0.001), at the 1st (p< 0.001) and 3rd months (p= 0.040). There was a significant decrease in VAS night pain in group 1 (p= 0.024), and a significant increase in pain-free grip strength (p= 0.002) after treatment. PRTEE-Pain scores decreased in group 1 after treatment (p< 0.001), 1st (p< 0.001) and 3rd months (p= 0.001). MWM plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength.

Platelet-Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta-Analysis of Randomized Controlled Trials.

ObjectiveTo compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis.Type of StudyNetwork meta‐analysis.Literature SurveyRandomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library.MethodologyTwo researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term.SynthesisTwenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8).ConclusionPRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.

Validity and usability of a smart ball-driven serious game to monitor grip strength in independent elderlies.

Telemonitoring is one of the most expedient answers to the strong need for preventive care imposed by the rapidly aging society. We propose an innovative solution to the detection of early signs of frailty by presenting a serious game controlled by a smart sensorized soft plastic ball, designed to achieve continuous home-based monitoring of muscle weakness in older adults. Design, development, and testing of the smart ball and of the game interface devised to guide the monitoring procedure are presented. Reliability and concurrent validity of the system in measuring maximal grip strength against the clinical standard Jamar® were evaluated. Serious game usability and acceptance were investigated on 26 elderlies. Smart ball and Jamar measurements were well correlated (0.76 and 0.80 for dominant and non-dominant hands) and test-retest reliability of pressure measurements was excellent (intraclass correlation coefficient >0.94). The serious game was well accepted by the 96.1 percent of participants, who provided a strongly positive usability score (87.7/100). The smart ball-driven serious game demonstrated excellent reliability and good validity in measuring grip strength. The proposed smart ball-driven serious game can be used for home self-monitoring of grip strength in elderlies.

Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis.

Background:Inadequate efficacy and significant side effect profile makes pharmacological treatment of Parkinson’s disease (PD) tremor challenging. Personalized dosing of botulinum toxin type A (BoNT-A) using tremor analysis has shown efficacy and safety for treating upper limb tremor. This study incorporated a novel, standardized treatment algorithm for determining injection pattern and BoNT-A dosing, customizable by the physician, in PD patients with disabling tremor in one or both arms.Methods:This open-label study included 47 PD participants (25 “De-novo” and 22 “L-dopa”) who received 4 serial BoNT-A treatments with follow-ups at 6 weeks post-treatment over 42 weeks. The treatment algorithm utilized kinematic tremor analysis of each participant’s whole arm tremor and determined the physician’s injection pattern of BoNT-A. Endpoints included changes in angular tremor amplitude, Fahn-Tolosa-Marin (FTM C) tremor scale, Movement Disorder Society-Unified Parkinson’s disease rating scale (MDS-UPDRS) tremor-related score, tremor-related quality of life questionnaire, Likert ratings of perceived weakness, and maximal grip strength.Results:BoNT-A significantly (p < 0.05) improved tremor amplitude (41.6%), quality of life (23.0%), UPDRS tremor score (29.6%), and arm function (FTM C; 24.6%) for both treatment cohorts from weeks 6 to 42. Maximum grip strength was reduced between 7.4% and 23.0% at follow-up visits and did not impact activities of daily living. Efficacy was obtained with first injection and remained without adjustment over two serial injection in 45% of participants.Conclusions:This is the first study to use a fully standardized treatment algorithm for personalization of BoNT-A injection patterns for disabling PD tremor over serial treatments. A sustained alleviation of tremor severity and improved arm function and quality of life fulfills an important unmet need for the treatment of PD tremor. This study demonstrated that BoNT-A can be administered as a monotherapy in tremor-dominant PD or as an add-on therapy for refractory PD tremor.

Long-Term Effects of Fatherhood on Morphology, Energetics, and Exercise Performance in California Mice (Peromyscus californicus).

In male mammals that provide care for their offspring, fatherhood can lead to changes in behavioral, morphological, and physiological traits, some of which might constitute trade-offs. However, relatively little is known about these changes, especially across multiple reproductive bouts, which are expected to magnify differences between fathers and nonreproductive males. We evaluated consequences of fatherhood in the monogamous, biparental California mouse (Peromsycus californicus) across seven consecutive reproductive bouts. We compared breeding adult males (housed with sham-ovariectomized females) with two control groups: nonbreeding males (housed with ovariectomized females treated with estrogen and progesterone to induce estrous behavior) and virgin males (housed with untreated ovariectomized females). At five time points (before pairing, early postpartum of the first litter, late postpartum of the second litter, early postpartum of the sixth litter, and late postpartum of the seventh litter or comparable time points for nonbreeding and virgin males), we measured males' body composition, hematocrit, predatory aggression, resting metabolic rate, maximal oxygen consumption (), grip strength, and sprint speed. We also weighed organs at the final time point. We predicted that fathers would have lower relative body fat and lower performance abilities compared with control groups and that these effects would become more pronounced with increasing parity. Contrary to predictions, breeding and control males differed in surprisingly few measures, and the number and magnitude of differences did not increase with parity. Thus, our expectations regarding trade-offs were not met. As reported in studies of single reproductive events, these results suggest that fatherhood has few costs in this species when housed under standard laboratory conditions, even across multiple reproductive bouts.

Normative reference values on handgrip strength among healthy adults of Dhulikhel, Nepal: A cross-sectional study.

Context:Handgrip strength (HGS) is the amount of static force that the hand can generate around the dynamometer and can be defined as the ability of the hand to hold the objects between the thumb and fingers. Handgrip measurement is simple but also a valid measure of overall muscle strength and also provides an objective index of functional integrity of upper extremity.Aims:To provide population-based HGS reference values for Nepalese adults from 19 to 70 years of age.Settings and Design:A cross-sectional study was conducted in Dhulikhel community among 526 participants.Methods and Materials:Jamar Dynamometer was used for measuring HGS based on the recommendation provided by the American Society of Hand Therapists.Statistical Analysis Used:Data were analyzed using STATA version 14.Results:Men exhibited higher HGS compared to women with maximum grip strength observed in age group of 19–29 which were 47.24 kg and 32.51 kg for men and women, respectively. HGS decreases with increasing age in both dominant and nondominant hands.Conclusions:The normative reference values provided in this study may serve as a guide for interpreting grip-strength measurements obtained from tested individuals.

Sarcopenia, long-term conditions, and multimorbidity: findings from UK Biobank participants.

BackgroundSarcopenia, the loss of muscle strength and mass, predicts adverse outcomes and becomes common with age. There is recognition that sarcopenia may occur at younger ages in those with long‐term conditions (LTCs) as well as those with multimorbidity (the presence of two or more LTCs), but their relationships have been little explored. Our aims were to describe the prevalence of sarcopenia in UK Biobank, a large sample of men and women aged 40–70 years, and to explore relationships with different categories of LTCs and multimorbidity.MethodsWe used data from 499 046 participants in the baseline of UK Biobank. Our main outcome was probable sarcopenia based on maximum grip strength below sex‐specific cut‐points. Participants' LTCs were recorded during an interview and categorized against a hierarchy. We used logistic regression to examine the independent associations between each category of LTCs and probable sarcopenia, including adjustment for age, sex, and body mass index. We also examined the association with multimorbidity.ResultsProbable sarcopenia had an overall prevalence of 5.3% and increased with age. The categories with the strongest associations with probable sarcopenia were musculoskeletal/trauma [OR 2.17 (95% CI: 2.11, 2.23)], endocrine/diabetes [OR 1.49 (95% CI: 1.45, 1.55)], and neurological/psychiatric [OR 1.39 (95% CI: 1.34, 1.43)] LTCs. Almost half of the sample (44.5%) had multimorbidity, and they were at nearly twice the odds of probable sarcopenia [OR 1.96 (95% CI: 1.91, 2.02)] compared with those without.ConclusionsWe have shown an overall prevalence of 5.3% of probable sarcopenia at ages 40–70 in UK Biobank. The risk of probable sarcopenia was higher in those with some categories of LTCs, suggesting that these groups may stand to benefit from assessment of sarcopenia, during mid‐life as well as old age.

Changes in Performance and Morning-Measured Responses in Sport Rock Climbers.

The aim of this study was to determine changes in climbers’ hormonal, cardiovascular, neuromuscular, sleep and fatigue status, and their relationship with performance and workloads during a sport rock climbing camp. Mean difficulty of individual leading climbing routes (mean Difficulty) was calculated for six male, intermediate level sport rock climbers participating in a 2-week camp in Orpierre. Additionally, each morning climbers were tested for: cortisol (d-Cortisol) and testosterone (d-Testosterone) concentrations, testosterone/cortisol ratio (T/C), heart rate and heart rate variability in supine (d-L-HR, d-L-SD1, d-L-SD2) and standing positions (d-S-HR, d-S-SD1, d-S-SD2), difference in S-HR and L-HR (HR-S-L), maximal voluntary hand grip strength (MVC), sleep duration (Sleep) and the self-perception of fatigue (M-Fatigue). Only M-Fatigue and d-Testosterone did not change significantly during the camp. Changes in other variables were large and significant, especially in the second week of the camp when the mean Difficulty was > 70%. The greatest changes were noted on the last day, when T/C, HR-S-L, and Sleep decreased and d-Cortisol, d-L-HR, and d-SD1 increased. The monitoring of the uncoupling of neuromuscular, hormonal, and cardiovascular markers can be instrumental in determining the level of athletes’ morning fatigue and readiness during a climbing camp. An increase in d-Cortisol and a decrease in T/C and HR-S-L are relevant indicators of overreaching in sport climbers.

Effects of depression on the condition of older inpatients with fracture and preexisting cognitive impairment

Aim Few studies of depression have examined older inpatients with fracture and preexisting cognitive impairment. The current study sought to confirm whether depression affects the condition of older inpatients with fracture who also have cognitive impairment, and to investigate the extent to which depression affects activities of daily living. Methods This was a retrospective cross-sectional study. The subjects were older inpatients with fracture and preexisting cognitive impairment. We examined data within 1 week of hospitalization, obtained from medical records. The data included demographic information, the motor Functional Independence Measure, Charlson Comorbidity Index, Mini-Mental State Examination, Geriatric Depression Scale 15, Geriatric Nutritional Risk Index, Skeletal Muscle Index and maximum grip strength test. These variables were compared between the two groups (with and without depression), and multiple regression analysis was performed with the motor Functional Independence Measure as the dependent variable. Results The subjects were 68 patients. Only the motor Functional Independence Measure was significantly lower in the depression group than the non-depression group. Multiple regression analysis confirmed that depression strongly affected activities of daily living. Conclusions In considering the recovery of older inpatients with fracture and preexisting cognitive impairment, it is important to take the effects of depression into account. Implications for rehabilitation The number of older fracture inpatients with cognitive impairment is predicted to increase, and such patients have a high prevalence of depression. Depression strongly affected Activities of Daily Living in older inpatients with fracture and pre-existing cognitive impairment. Focusing on depression assessment and intervention is important for rehabilitation of older fracture inpatients with cognitive impairment.

GENOME-WIDE ANALYSIS OF LOW STRENGTH IN OLDER PEOPLE: META-ANALYSIS OF &amp;gt;250,000 VOLUNTEERS IN 16 COHORTS

Dynapenia or muscle weakness is a core feature of sarcopenia and frailty, and leads to significant functional impairment in older adults. We aimed to identify genetic variants associated with dynapenia in older adults, to shed light on the underlying mechanisms. A large-scale meta-analysis of >250,000 volunteers of European descent from 16 cohorts in the CHARGE and GEFOS consortia aged 60+ years at assessment is underway, using maximum hand grip strength to define dynapenia. Preliminary analysis in UK Biobank found that dynapenia is associated with nine genomic loci at genome wide significance (p<5x10-8), with differences between men and women, suggesting sex-specific routes to dynapenia. These results suggest that there are specific genetic determinants of low strength in older adults, and these differ from the determinants of normal-range strength differences. The full meta-analysis of all cohorts will extend these findings. Understanding the biological mechanisms may lead to geroscience interventions.

HAND GRIP STRENGTH ASSESSMENT IN A HOME-DELIVERED MEAL PROGRAM: FEASIBILITY AND PRELIMINARY FINDINGS

Declining hand grip strength is associated with adverse health outcomes and is a relatively quick and easy-to-administer functional assessment; however, grip strength is not routinely assessed in home-delivered meal (HDM) programs. The purpose of this sub-study was to test if grip strength assessment is feasible and useful in a HDM population. Among HDM clients (n=258) who completed health assessments between 2016 and 2018, a voluntary convenience sample of 34 HDM clients (23 women, 11 men) participated in the grip strength assessment sub-study. Sub-study participants were younger (72.2+/-7.35 vs. 77.0+/-10.50 years), with no other significant differences compared to the full sample of HDM participants. The average maximum grip strength was 21.99+/-6.97 kg for the dominant hand; 16 clients were categorized as having normal, 6 intermediate, and 12 weak grip strength. Normative categories for grip strength vary by gender because men typically have higher grip strength measures than women. In this population, more men were categorized as having weak grip strength compared to women (X (2, 34) =11.44, p=.03). In men, hand grip strength tended to be lower in those who reported a fall in the previous 6 months compared to those who did not report a fall (20.8+/-7.01 vs 29.3+/-6.32, p=.079). The gender differences and 8 kg difference in grip strength relative to reported falls are clinically meaningful in this vulnerable population. Future research is needed with a larger sample of HDM clients to confirm these preliminary findings.

Effects of Combined Resistance Plus Aerobic Training on Body Composition, Muscle Strength, Aerobic Capacity, and Renal Function in Kidney Transplantation Subjects.

Lima, PS, de Campos, AS, de Faria Neto, O, Ferreira, TCA, Amorim, CEN, Stone, WJ, Prestes, J, Garcia, AMC, and Urtado, CB. Effects of combined resistance plus aerobic training on body composition, muscle strength, aerobic capacity, and renal function in kidney transplantation subjects. J Strength Cond Res 35(11): 3243-3250, 2021-Immunosuppression and a sedentary lifestyle may exacerbate complications such as early graft dysfunction and muscle loss, and reduce patient survival after kidney transplantation (KT). Therefore, the purpose of this study was to evaluate changes in body composition (BC), muscular strength, aerobic, and renal function in KT subjects submitted to combined resistance plus aerobic training. Twelve KT subjects were randomly assigned into groups: (G1) 12 weeks of combined training (3 males and 4 females, 54 ± 3 years); or (G2) nonexercise control (5 females, 43 ± 18 years). The subjects were evaluated for BC (dual-energy X-ray absorptiometry), estimated V̇o2peak, right-hand maximal grip strength (RHMGS) and left-hand maximal grip strength (LHMGS), and renal function. Post-training revealed that G1 reduced body fat percentage (p = 0.046), uric acid (Δ = -0.87; p = 0.023), urea (Δ = -9.43; p = 0.032), and creatinine (Δ = -0.15; p = 0.045), increased fat-free mass, estimated V̇o2peak, RHMGS, LHMGS (p < 0.05), and estimated glomerular filtration rate (eGFR) (Δ = 11.64; p = 0.017). G2 increased urea (Δ = 8.20; p = 0.017), creatinine (Δ = 0.37; p = 0.028), and decreased eGFR (Δ = -16.10; p = 0.038). After 12 weeks, urea (Δ = 24.94; p = 0.013), uric acid (Δ = 1.64; p = 0.044), and creatinine (Δ = 0.9; p = 0.011) were lower, whereas eGFR (Δ = 36.51; p = 0.009) was higher in G1. These data indicate that combined training instigates positive changes in BC, muscular strength, aerobic capacity, and renal function after KT.

Mortality Risk Among Older People Who Did Versus Did Not Sustain a Fracture: Baseline Prefracture Strength and Gait Speed as Predictors in a 15-Year Follow-Up.

Physiological reserve, as indicated by muscle strength and gait speed, may be especially determinant of survival in people who are exposed to a health stressor. We studied whether the association between strength/speed and mortality risk would be stronger in the time period after a fracture compared to other time periods. Participants were population-based sample of 157 men and 325 women aged 75 and 80 years at baseline. Maximal 10-m gait speed and maximal isometric grip and knee extension strength were tested at the baseline before the fracture. Subsequent fracture incidence and mortality were followed up for 15 years. Cox regression analysis was used to estimate fracture time-stratified effects of gait speed and muscle strength on mortality risk in three states: (i) nonfracture state, (ii) the first postfracture year, and (iii) after the first postfracture year until death/end of follow-up. During the follow-up, 20% of the men and 44% of the women sustained a fracture. In both sexes, lower gait speed and in women lower knee extension strength was associated with increased mortality risk in the nonfracture state. During the first postfracture year, the mortality risk associated with slower gait and lower strength was increased and higher than in the nonfracture state. After the first postfracture year, mortality risk associated with lower gait speed and muscle strength attenuated. Lower gait speed and muscle strength were more strongly associated with mortality risk after fracture than during nonfracture time, which may indicate decreased likelihood of recovery.

Urinary Incontinence and Nocturia in Older Men: Associations with Body Mass, Composition and Strength in the Health ABC Study.

In younger men lower body mass is associated with fewer urinary symptoms, including incontinence and nocturia. However, lower body mass may have different implications in older men due to age associated muscle atrophy and decreased strength. We performed a prospective analysis of community dwelling men 70 to 79 years old in the multicenter Health ABC (Aging and Body Composition) study who underwent measurement of body mass on physical examination, composition using dual x-ray absorptiometry and strength according to grip and lower leg dynamometry. We evaluated associations with prevalent incontinence and nocturia on structured questionnaires as well as concurrent changes in urinary symptoms during 3 years using multivariate logistic regression. Of the 1,298 men analyzed 22% reported incontinence and 52% reported nocturia at baseline. Higher body mass index, fat mass and lower appendicular lean mass, and grip and quadriceps strength corrected for body mass index were associated with an increased prevalence of incontinence (each p <0.05). Higher body mass index and greater fat mass were also associated with an increased nocturia prevalence (each p <0.05). Concurrent 5% or greater decrease in body mass or fat mass was not associated with lower odds of new or worsening incontinence or nocturia, whereas a 5% or greater decrease in maximum grip strength was associated with higher odds of new or worsening incontinence. Older men with a higher body mass index and greater fat mass are more likely to report prevalent incontinence and nocturia. However, late life decreases in strength but not increases in body mass or fat mass were associated with a concurrent increase in urinary incontinence.

The effect of multimorbidity on physical performance in community-dwelling older adults in China: a retrospective, population-based cohort study

BackgroundFew studies have been done on the associations of multimorbidity on physical performance in China. We investigated the associations of multimorbidity and its patterns with physical performance in older adults (60–100 years of age). MethodsIn this retrospective, population-based cohort study, we used data from participants recruited in the China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, and excluded those participants with missing data on physical performance (n=1893), multimorbidity (n=2), and weight (n=46). Multimorbidity was assessed via questionnaires, and physical performance, as the primary outcome, was measured by maximum grip strength (kg) and gait speed (m/s). Grip strength was assessed using a hydraulic handgrip dynamometer, and gait speed by asking participants to walk along a 2·5 m walkway at twice their normal walking speed. These measures were done at baseline and at each follow-up assessment. Patterns of multimorbidity were assessed using exploratory factor analysis, and a standardised factor score for each pattern was calculated for each participant. Generalised estimating equations were used to evaluate the associations between multimorbidity, multimorbidity pattern scores, and physical performance after adjusting for potential confounding factors. FindingsWe included data from 10 067 participants whose average age at baseline was 67·3 years (SD 6·7); 5004 (50·4%) were women and 5063 (49·6%) were men. Four multimorbidity patterns were identified at baseline: respiratory, cardio-metabolic, visceral, and vascular-visual. The baseline average grip strength was 29·8 kg and gait speed was 0·8 m/s for the whole cohort; men had a higher grip strength than women (34·3 kg vs 22·5 kg, p<0·0001) but gait speed was similar (0·75 m/s vs 0·79 m/s, p=0·50). An increasing number of comorbidities was significantly associated with poorer grip strength, with the greatest estimate for participants with three or more chronic conditions (β=–1·42, 95% CI −1·87 to −0·98; p<0·0001). Respiratory (β=–0·47, 95% CI −0·69 to −0·25; p<0·0001), visceral (–0·41, −0·64 to −0·18; p=0·0006), and vascular-visual (–0·82, −0·82 to −0·31; p<0·0001) patterns were also associated with reduced grip strength. No significant relationship was identified between multimorbidity, as well as its four patterns, and gait speed. However, participants with two conditions (odds ratio [OR] 1·57, 95%CI 1·32 to 1·88; p<0·0001) and with three or more conditions (1·60, 1·34 to 1·92; p<0·0001) both had an increased risk of poor gait speed (≤0·8 m/s). Respiratory (OR 1·14, 1·07 to 1·22; p=0·0001), visceral (1·11, 1·04 to 1·18; p=0·0027), and vascular-visual (1·16, 1·08 to 1·24; p<0·0001) patterns were also associated with increased risk of poor gait speed. InterpretationThe number of chronic conditions in older people has a significant negative relationship, and multimorbidity patterns are differentially associated, with physical performance. Maximum grip strength and poor gait speed could therefore be useful performance measures to incorporate into the care of older patients with multimorbidities. FundingNational Natural Science Foundation of China (grant 81703304).

The Effect of Stretching and Strengthening Exercise in the Management of Lateral Epicondylitis

Background: Lateral Epicondylitis (LE) is a common overuse injury of Elbow that generates pain over the lateral aspect of elbow. LE is one of the most common causes of elbow and forearm pain encountered in clinical practice commonly associated with resistant wrist or finger extension and gripping activities. The management of LE is enlightened by various form physical modalities and therapeutic exercise like stretching and strengthening exercise. The purpose of this prospective study was to investigate the effects of stretching and strengthening exercises on pain and grip strength of LE. Materials and methods : Eighty patients were enrolled, non-randomized, and divided into 2 groups an experimental Group-A of 40 (44.5 ± 1.5 years) whose receive therapeutic exercise in the form of stretching and strengthening of common extensor forearm muscle and a control Group-B of 40 (41.4 ±2.5 years). Study duration was about one year. Both Group received UST over the lateral aspect of elbow with the 3MHz frequency and 0.5 watt/cm2 intensity for 5 min three sessions per week for six weeks. They were evaluated at every weeks of treatment for six weeks. Comparison between Group-A and Group-B was done with Wilcoxon Rank sum test and unpaired ttest. Results: By the end of the trial period, statistical data analysis in between the two groups showed a significant improvement in pain scores of VAS and the maximal isometric grip strength at sixth week. Conclusion: This study depicts that therapeutic exercise is more effective in reducing pain and improvement of grip strength. So, stretching and strengthening exercise should be considered as a main therapeutic armamentarium in the management of LE.&#x0D; JCMCTA 2019 ; 30 (1) : 36-42

Investigating the functional grip strength of elderly fallers in Singapore

Background:Static grip strength has been a reliable method for assessing the functional capacity of the individual and can be a useful marker for identifying elderly people at risk of functional deterioration leading to a fall. However, static grip strength alone may not represent the true maximum strength that an individual could exert in his/her daily life, especially if the task requires simultaneous forces from gripping and a forearm twisting action, which is termed as functional isometric grip strength. Hence, the objectives of this study were to determine the differences in the fallers’ grip strengths at static-neutral grip position and during isometric forearm pronation/supination, as well as the differences between the maximum and sustained isometric grip strengths.Methods:Data were analysed from 31 elderly people (11 males and 20 females) aged 70 and over. Using a custom-made hand strength measurement device, three measurements were taken: (1) grip strength in neutral forearm position; (2) grip strength during isometric forearm pronation; and (3) grip strength during isometric forearm supination.Results:Elderly fallers could only achieve approximately 60%–80% of the maximum normative strength. Additionally, it was found that their functional isometric grip strengths were generally weaker than their static maximal grip strength, especially during isometric supination as either maximum or sustained isometric supination grip strengths (Dominant hand: 10.6 kg and 8.5 kg, respectively (males); 6.0 kg and 4.4 kg, respectively (females)).Conclusion:Elderly fallers are weaker when their grip is subjected to additional torque, endurance or both. Hence, these findings have potential implications for designing better screening tools for the geriatric population.

Cognitive and motor aspects of cancer-related fatigue.

BackgroundCancer‐related fatigue (CRF) is a debilitating symptom frequently reported by patients during and after treatment for cancer. CRF is a multidimensional experience and is often solely assessed by self‐report measures. The goal of the study is to examine the physical and cognitive aspects of self‐reported CRF using a cognitive function test and a physical fatigue index in order to provide objective measures that can characterize the CRF phenotype.MethodsA total of 59 subjects with nonmetastatic prostate cancer receiving external beam radiation therapy were included in the study. Fatigue was measured using the Functional Assessment of Cancer Therapy‐Fatigue (FACT‐F) questionnaire. Cognitive characteristics of CRF was measured using the Stroop Color‐Word Interference computerized test and the motor aspect of fatigue was measured using the static fatigue test using a handgrip dynamometer.FindingsFunctional Assessment of Cancer Therapy‐Fatigue scores significantly correlated with the Stroop Interference score, but not performance accuracy in all test conditions. Fatigued subjects exhibited a more rapid decline to 50% of maximal strength and increased static fatigue index in the handgrip test, whereas maximal grip strength was not affected.ConclusionsThe results suggest that CRF exhibits both cognitive and physical characteristics. Subjective fatigue was associated with increased time required to overcome cognitive interference, but not cognitive performance accuracy. Fatigued patients exhibited decreased physical endurance and the ability to sustain maximal strength over time. These objective measures may serve as valuable tools for clinicians to detect cognitive and physical impairment associated with CRF.